Reogranisation of the NHS

You can read the speech that I made to the House of Commons on the reoganisation of the NHS on 26 March 2011, the full text of which is below.  You can read the entire debate on the parliamentary website.

This costly reorganisation of the NHS has no mandate from the British people, and no support from health professionals or, apparently, the Liberal Democrats. It will be the end of the NHS that we know and love. As I have said before, the NHS is not just an organisation that plans and provides our health services; it also represents the values of our society by which this country sets much store. Contrary to the assertions from the Government Front Bench, the NHS reorganisation defined in the Health and Social Care Bill will wipe out the founding principles of the NHS in one fell swoop.

For the first time since the NHS was established in 1948, the Secretary of State for Health will not have a duty to provide a comprehensive health service. I will let that sink in. Instead, it is to be replaced with duties to “promote” and to “act with a view to securing”

health services—weasel words that beggar belief. The original duty is fundamental to protecting the provision of a universal, comprehensive health service. It is the foundation on which the NHS was established. Without it, we will no longer be sure that a comprehensive national health service will be provided, and Members of Parliament will no longer be able to hold the Secretary of State to account on behalf of the constituents who elected them.

Rather embarrassingly for the Secretary of State, he might recall that, when he presented evidence to the Health and Social Care Bill Committee, I questioned him on this and asked him why he was repealing that fundamental duty. He said that he was not. However, it is absolutely clear from the Bill’s explanatory notes that that is exactly what will happen. Paragraph 64 states that clause 1 “removes the current duty on the Secretary of State in subsection (2) of section 1 to provide or secure the provision of services for the purposes of the health service.”  That duty is absolutely core: the NHS was established to provide a universal, comprehensive health service, but that will soon be gone. It is worrying that the Secretary of State did not appear to understand the implications of competition law, or to know what was being repealed in his own Bill.

The Government have suggested that these functions will now be the duty of the NHS commissioning board and the GP consortia, but the exercise of the functions will be discretionary. There will be no requirement to provide those services. So I repeat that the Bill will take away the duty to provide a comprehensive, universal health service.

Nadine Dorries (Mid Bedfordshire) (Con): Will the hon. Lady give way?

Debbie Abrahams: No, I am sorry, I am going to make progress so that everyone gets a chance to speak.

The Government have also said that the NHS commissioning board will ensure that NHS delivery is free from political control, but I am not so sure about that. The Bill contains a variety of contradictions, particularly in relation to the Secretary of State’s appointments to the various quangos. Another of the founding principles under threat from this Government is that treatment should be based on clinical need and not the ability to pay. We heard the Secretary of State say that that would be protected, but the Government’s reorganisation of the NHS will result in opening up that fundamental principle. The NHS commissioning board and the GP consortia will have the power to generate income, perhaps by charging for non-designated services. What constitutes designated and non-designated services has yet to be defined, however. My hon. Friend the Member for Leicester West (Liz Kendall) tried to get some elucidation on that, but none was forthcoming.

Mr Lansley: Will the hon. Lady give way?

Debbie Abrahams: No, I am sorry, I want to make some progress—[Hon. Members: “Give way!”]

Mr Deputy Speaker (Mr Lindsay Hoyle): Order.

Debbie Abrahams: Not only are the founding principles of the NHS in danger of being wiped out, but its culture—the reason that most of its employees work for the NHS—will go as well. The whole ethos of the NHS will change. It will now be driven by competition and consumer interests—[ Interruption. ]

Mr Deputy Speaker: Order.

Debbie Abrahams: My first question to the Secretary of State was about the proposal that the NHS commissioning board will be able to award bonuses to the GP consortia that it deems to be adopting innovative measures. The Bill states:

“The Board may make payments as prizes to promote innovation in the provision of health services.”

That means bonuses within the NHS based on innovation, which is anathema to the NHS and not what we want for it. This is indicative of the Bill as a whole. Central to the reforms are increasing competition across the NHS and opening it up to providers from the private and voluntary sectors. The Government claim that increasing competition drives down costs and improves quality, but there is evidence from across the world—in the US and Europe—that that is not the case. It does not improve quality at all in health care systems.

Although I am glad to see that the Government have reversed their position on price competition, as of yesterday they were still wedded to establishing Monitor as a powerful economic regulator with the duty to promote competition. As has been pointed out, our health services will be subject to EU competition law for the first time. By forcing these GP consortia to put any services out to competitive tender—even if they are working well and patients and the public are happy with them—the Bill encourages “any willing provider” to—

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